FUNCTIONAL ENDOSCOPIC SINUS SURGERY VERSUS CONTINUED MEDICAL THERAPY AS INITIAL MANAGEMENT STRATEGY IN MEDICALLY REFRACTORY CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: A MULTICENTRE STUDY

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) substantially impairs quality of life. Optimised medical therapy (OMT) is the foundation of management and functional endoscopic sinus surgery (FESS) is reserved for disease persisting despite it. Prospective comparative data from Indian populations remain limited. Methods: A prospective multicentre comparative cohort study was conducted at three tertiary-care hospitals in Karnataka, Telangana, India (March 2024 to June 2026). Of 220 adults aged 18–70 years with CRSwNP persisting beyond 12 weeks despite conservative management, 110 underwent FESS followed by continued OMT and 110 continued OMT alone; treatment was selected by shared decision-making, not randomisation. Outcomes were the Sinonasal Outcome Test-22 (SNOT-22), Lund–Kennedy and Lund–Mackay scores and symptom visual analogue scales. Results: The cohort comprised 143 men and 77 women of mean age 43.8 ± 11.6 years, with comparable baseline characteristics. Mean SNOT-22 fell from 58.6 to 16.8 after FESS and from 57.9 to 31.7 with OMT alone (p<0.001); the between-group difference of 14.9 points exceeded the 8.9-point minimal clinically important difference. Lund–Kennedy scores were 2.1 versus 5.3 and Lund–Mackay scores 5.4 versus 9.8 (p<0.001 for both). Recurrence occurred in 12 participants (10.9%) versus 31 (28.2%) (p=0.002; number needed to treat 6) and additional systemic corticosteroids in 15 (13.6%) versus 43 (39.1%) (p<0.001; number needed to treat 4). Five participants (4.5%) underwent revision surgery and 37 (33.6%) crossed over from OMT to FESS. Conclusion: FESS with continued medical therapy was associated with greater improvement than medical therapy alone. Because allocation was not randomised, crossover occurred and follow-up was incomplete, these findings indicate an association between the initial strategy and outcome rather than a causal effect.